Form 92-033 - Request For Change, Correction Or Cancellation Of Tax Permit
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1IOWA
Request for Change, Correction
INSTEAD OF MAILING THIS
depar tment of Revenue and Finance
FORM, YOU MAY APPLY ONLINE
or Cancellation of Tax Permit
AT
IN THE E-SERVICES CATEGORY
Return This Form To:
Do you have questions on Iowa taxes?
Registration Services
Iowa Department of Revenue and Finance
e-mail: idrf@idrf.state.ia.us
P.O. Box 10465
1-800-367-3388
Des Moines, IA 50306-0465
(Iowa, Omaha, Rock Island, Moline)
Fax: 515/281-3906
515/281-3114 (Local)
Legal Name _________________________________________________________
Trade Name _________________________________________________________
Address ____________________________________________________________
Indicate by checkmark and permit number those permit records you request to change, correct or cancel.
Sales Tax Permit
No. ___________________________________
Motor Vehicle Fuel Tax Permit
No. ___________________________________
Consumer's Use Tax Permit
No. ___________________________________
Retailer's Use Tax Permit
No. ___________________________________
No. ___________________________________
Household Hazardous Material Permit
Employer Withholding Permit
No. ___________________________________
Other
No. ___________________________________
Checkmark and complete the applicable area(s):
Cancel: Reason: _________________________________ Effective date: ____________________
Reinstate: Reason: _________________________________ Effective date: ____________________
Change business/trade name to: ______________________________________________________
Change mailing address to: ___________________________________________________________
_________________________________________________________________________________
Change location address to: (PO Box Not Allowed) _______________________________________
_________________________________________________________________________________
Add corporate officer name: __________________________________________________________
Address: _________________________________________ Soc. Sec. No. ____________________ (must include)
Delete corporate officer name: _____________________ Soc. Sec. No. ____________________ (must include)
Add partner name: __________________________________________________________________
Address: _________________________________________ Soc. Sec. No. ____________________
Delete partner name: _______________________________ Soc. Sec. No. ____________________
Change of filing frequency: __________________________________________________________
Other corrections: __________________________________________________________________
You will also need to complete a new permit application form if you are changing:
• ownership, incorporating
• location address from one Iowa county to another and have a sales tax permit or consumer's use tax permit
Owner/Officer Signature: _____________________________________________ Date: ________________
Title: _____________________________________________________________
92-033 (6/20/02)
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